When Elders Neglect Their Own Care: What You Should Know About Risks and Warning Signs

The stories are shocking and tragic:

A couple, both suffering from dementia, surviving on Pepsi and granola bars in a home so full of junk that it was difficult for them to walk safely. The husband had once been competent and in charge, but neither he nor his wife could now understand their life-threatening situation.

An elderly woman living alone, 40 pounds underweight, unaware that she had hung her soaking underwear to dry without first washing out the urine. Her desk was piled with unpaid bills, and she clearly wasn’t eating properly. But her cat was always fed.

A 78-year old man who refused wound care for oozing sores on his legs, which he concealed with ace bandages. He claimed to be seeing his podiatrist for treatment, but actually sat in his car for the length of the appointment and then drove home. The man later died in a nursing home for continuing to refuse treatment for his infections.

Elderly Self-Neglect More Common Than Other Forms of Elder Abuse or Neglect

These are just a few cases of elderly self-neglect, a growing problem that commonly goes unreported, according a survey of elder care experts issued in September by the National Association of Professional Geriatric Care Managers (NAPGCM). The survey finds that self-neglect among seniors is the most common form of non-financial elderly abuse/neglect encountered by care managers, far outpacing encounters with physical or sexual abuse, or neglect by others.

The National Adult Protective Services Association (NAPSA) defines self-neglect as “an adult’s inability, due to physical or mental impairment or diminished capacity, to perform essential self-care….” Life-style choices or living arrangements alone do not prove self-neglect. According to NAPSA, in many communities, self-neglect accounts for more than 50 percent of adult protective service referrals and caseloads.

Key Findings of the NAPGCM Survey

NPAGCM surveyed 300 geriatric care managers from September 12-16, 2014:

  • 92 percent of care managers said that elderly self-neglect was a significant problem in their community, with 52 percent describing it as a significant and growing problem.
  • 94 percent of care managers agreed that elderly self-neglect is a largely hidden problem, with cases frequently or mostly going unreported.
  • 76 percent of the respondents reported that elderly self-neglect is the most common non-financial form of elder abuse/neglect that they encounter in their practices. Another form of neglect—by family or others—was the second most commonly reported form (16 percent), followed by emotional/psychological abuse (8 percent) and physical and sexual abuse (1 percent).

Know the Six Warning Signs of Elderly Self-Neglect

“Elderly self-neglect is a growing and largely hidden national problem,” according to Emily Saltz, NAPGCM President. “Families and friends need to know the warning signs and be on the look-out to safeguard their elderly loved ones.”

These six warning signs of elderly self-neglect were most often cited by the surveyed care managers:

  1. Signs of poor personal hygiene/not bathing or taking care of hair and nails (92%)
  2. Poor medication management or refusing to take medications (89%)
  3. Signs of dehydration, malnutrition or other unattended health conditions (75%)
  4. Unsanitary or very unclean living quarters (72%)
  5. Signs of unpaid bills, bounced checks or utility shut-offs (64%)
  6. Lack of adequate food in house or signs of weight loss (63%)

Two significant population trends point to the increasing risk of elderly self-neglect. A government report found that a record 11.3 million older Americans—fully half of women age 75 or older—now live by themselves. And, according to the Alzheimer’s Association, the number of Americans with Alzheimer’s disease and other dementias will nearly triple, from 5 million to as many as 16 million by 2050.

What should be done? Where and how to report? The National Center on Elder Abuse provides a listing of resources in every state for reporting and responding to cases of elderly self-neglect.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsGCM.

The National Association of Professional Geriatric Care Managers (NAPGCM) was formed in 1985 to advance dignified care for older adults and their families. Geriatric Care Managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. They assist older adults who wish to remain in their homes, or can help families in the search for a suitable nursing home placement or extended care if the need occurs. 


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